术毕静脉滴注醒脑静对术后谵妄相关量表及细胞因子的影响

柯海; 于波; 孙蔚明; 赵新生; 丁玲玲

doi:10.13898/j.cnki.issn.1000-2020.07.019

术毕静脉滴注醒脑静对术后谵妄相关量表及细胞因子的影响

Effect of the intravenous dripping Xingnaojing injection at the end of operation on the related scales and cytokines of postoperative delirium

摘要

摘要:
目的对高龄既往脑卒中病人，在腰椎手术术毕时静脉滴注（静滴）醒脑静，观察术后谵妄相关量表及细胞因子的变化。
方法选取既往有脑卒中史的病人40例，全静脉麻醉下接受腰椎手术。随机表法分为醒脑静组和对照组，各20例。全麻诱导及维持均以丙泊酚效应室靶控和瑞芬太尼效应室靶控，术中以脑电双频谱指数（BIS）指导维持麻醉深度介于40~60。术毕停止输注丙泊酚和瑞芬太尼时，醒脑静组经静脉滴注醒脑静注射液10 mL+0.9%氯化钠溶液10mL，对照组经静脉滴注0.9%氯化钠溶液20mL，等待病人自行苏醒。于病人入室前（T0）、术毕1d（T1）和术毕3d（T2）测定简易精神状态检查（MMSE）和谵妄评定方法（CAM）量表评分。于病人入室前（T0）和术毕1d（T1）抽取静脉血测定白细胞介素（IL）-6和S-100β。
结果醒脑静组的MMSE总分组间比较在T1、T2时间点高于对照组（P < 0.05~P < 0.01），组内比较各时间点差异无统计学意义（P>0.05）；对照组组内比较各时间点MMSE总分差异有统计学意义（P < 0.05），在T1、T2时间点低于T0时间点（P < 0.05）。醒脑静组定向力组内比较在T2明显低于T0（P < 0.05），对照组定向力组内比较在T1、T2低于T0（P < 0.05~P < 0.01）。醒脑静组回忆能力组间比较在T1、T2高于对照组（P < 0.05~P < 0.01）。醒脑静组CAM评分组间比较在T2低于对照组（P < 0.05），组内比较在T2明显高于T0、T1（P < 0.01）；对照组CAM评分组内比较在T2明显高于T0、T1（P < 0.01）。醒脑静组病人的IL-6组间比较T1比对照组低（P < 0.05），组内比较T1与T0差异无统计学意义（P>0.05）。对照组IL-6组内比较T1和T0升高（P < 0.05）。S-100β组间比较在T0、T1差异无统计学意义（P>0.05），组内比较T1和T0差异亦无统计学意义（P>0.05）。
结论醒脑静注射液10mL术毕时应用可在一定程度抑制高龄既往脑卒中病人行腰椎手术后MMSE评分的下降趋势，抑制CAM量表的上升趋势，且能减少IL-6的分泌。

Abstract:
Objective o observe the changes of postoperative delirium-related scales and cytokines in elderly patients with stroke after intravenous dripping Xingnaojing injection at the end of lumbar spinal surgery.
Methods Forty patients with stroke were treated with lumbar spine surgery under general intravenous anesthesia, and divided into the Xingnaojing group and control group using random table method (20 cases in each group).The induction and maintenance of general anesthesia were controlled by propofol effect room and remifentanil effect room, and the EEG dual spectrum index (BIS) was used to guide the maintenance of anesthesia depth between 40-60.When the infusion of propofol and remifentanil stopped at the end of operation, the Xingnaojing group was intravenously infused with 10 mL Xingnaojing injection and 10 mL of 0.9% sodium chloride solution, the control group was intravenously infused with 20 mL 0.9% sodium chloride solution, and the patients were self-resuscitation.Before the patient entering the room (T0), after 1 day of operation (T1), and after 3 days of operation (T2), two groups were investigated using the mini-mentalstate examination (MMSE) and confusion assessment method (CAM) scale.The serum levels of interleukin 6 (IL-6) and S-100β in two groups were measured at T0 and T1.
Results The total score of MMSE in Xingnaojing group was higher than that in control group at T1 and T2 (P < 0.05-P < 0.01), and the differences of which in Xingnaojing group among different time-points were not statistically significant (P>0.05).In control group, the differences of the total score of MMSE among different time-points were statistically significant (P < 0.05), and which at T1 and T2 were lower than that at T0 (P < 0.05).The directional force in Xingnaojing group at T2 was significantly lower than that at T0 (P < 0.05), and which in control group at T1 and T2 were lower than that at T0 (P < 0.05 to P < 0.01).The recall abilities in Xingnaojing group at T1 and T2 were higher than that in control group (P < 0.05 to P < 0.01).The CAM score in Xingnaojing group at T2 was significantly lower than that in control group (P < 0.05), the CAM score in Xingnaojing group at T2 was significantly higher than that at T0 and T1 (P < 0.01), and the CAM score in control group at T2 was significantly higher than that at T0 and T1 (P < 0.01).The IL-6 level in Xingnaojing group at T1 was lower than that in control group (P < 0.05), the difference of the IL-6 level in Xingnaojing group between T2 and T0 was not statistically significant (P>0.05), and the IL-6 level in control group at T1 increased compared with at T0 (P < 0.05).The differences of the levels of S-100β between two groups at T0 and T1, and between T0 and T1 in two groups were not statistically significant (P>0.05).
Conclusion The application of Xingnaojing injection at the end of surgery can inhibit the downward trend of MMSE score, prevent the upward trend of CAM scale, and reduce the secretion of IL-6 in elderly patients with stroke to some extent.

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